The Alan Katz Health Care Reform Blog

Health Care Reform From One Person's Perspective

It’s Time for President Obama to Define Health Care Reform

Posted by Alan on October 5, 2009

Now comes the fun part. With the Senate Finance Committee poised to pass its version of comprehensive health care reform we get to one of the more difficult segments of the Kabuki dance: Speaker Nancy Pelosi and Senate Majority Leader Harry Reid must now reconcile the bills passed by multiple committees into a blended proposal. Which means the time is right for President Barack Obama to publicly define what, exactly, is “Obamacare”.

First some background. In the House, different versions of health care reform legislation have been passed by the House Ways & Means, Energy & Commerce, and Education & Labor committees. To be more precise, while the legislation moved forward by Ways & Means and Education & Labor were very similar, moderate Democratic members on the Energy & Commerce committee gained significant changes in that committee’s version. Speaker Pelosi will now combine the three versions into a “Manger’s Bill.” This is the version that will be debated and voted upon by the full House.

What’s makes Speaker Pelosi’s mash-up of the House Committee’s health care reform bills important is that any changes must be imposed upon it. Her version of the bill is the “default” position. From a legislative process perspective, this puts those seeking changes to the legislative language at a disadvantage.

The same blending process is underway in the Senate. There the task is even harder. The Senate Health, Education, Labor and Pensions Committee passed a liberal version of health care reform; the Senate Finance Committee’s plan is much more moderate. The gap between them is far greater than that between the three House committee’s bills. The Associated Press describes Senator Reid’s efforts to blend two disparate health care reform bills as “mission seemingly impossible.” Given the differences in the how the two Committees addressed costs, taxes, whether there should be a government-run plan, the obligation of employers to provide coverage and other controversial items, “seemingly impossible” may be an understatement.

Unless President Obama dives deeper into the details than has publicly been the case. The White House has been engaged in Congressional health care reform negotiations for some time. According to news reports, White House Chief of Staff Rahm Emanuel, formerly part of the House Leadership, has been the Administration’s point person in these discussions. Until recently, President Obama has been willing to let Congress thrash out the thorny issues related to health care reform, setting forth broad principles. Beginning last month the president has offered more specifics, but hardly enough to clearly define what his version of health care reform looks like. At least not publicly.

With all the Congressional committees having taken a position, the time has come to get specific. Yes, the White House could leave it to Speaker Pelosi and Senator Reid to fashion compromises that can pass their respective chambers, but that only postpones the Administration’s day of reckoning. For after the House and Senate passes their differing versions of reform, a conference committee (made up of both Senators and Representatives) will convene to fashion the final bill. If President Obama waits until the conference committee convenes to publicly engage in the nitty-gritty of reform, it could be too late. Legislators will have been forced to make numerous politically challenging votes. The political payback if the White House then makes those votes unnecessary would be … ugly.

President Obama needs to make his health care reform vision known now, before those votes. He needs to say “this is acceptable;” “this is not.”  He needs to spend his political capital to define Obamacare, to give lawmakers the cover they need to make tough votes, and to rally his considerable grassroots organization behind specific legislation.

Publicly defining what he wants in the bill is a huge political risk for President Obama. His positions will anger some supporters and give opponents mounds of ammunition to use against him. Whatever changes Congress makes to the president’s reform plan will be described by the jabbering cable network pundits as a defeat for the Administration. If he accepts those changes he’ll be accused of weakness and flip-flopping. (One of the most insightful columnists around, Richard Reeves recently explained the value and wisdom of political leaders capable of changing their minds).

But the greater risk to the Administration is failing to achieve meaningful health care reform. And if health care reform does pass, the messiness of the process will be soon forgotten. The odds of President Obama getting a health care reform bill sent to his desk increases exponentially if Congress – and the public – have a clear understanding of the Administration’s legislative ambitions.

The policy and political pieces are all on the table. Selecting from among the various provisions contained in the five variations of health care reform passed by Congressional committees won’t be an easy, but it is necessary. President Obama wanted Congress to participate in the reform process. They have. Now it’s his turn.


11 Responses to “It’s Time for President Obama to Define Health Care Reform”

  1. daniel lane said

    Cut obama some slack !.. this is a serious issue so he has to handle the situation delicately .. thanks

    • D Squared said

      Cut O’Bama some slack? This is a man who had all the answers neatly tied up into whatever little package he needed the American public to believe in order for him to win this election.
      Remember, he had all the answers, had all the plans for “change”…well, he had the word “change”, not the “Plan”.
      And, I believed in him, too.

      The only people Americans need to believe in are themselves and what our government is supposed to represent. The people.

      The ONLY one person I believe who is capable of telling the public the truth is Ron Paul.
      He educates the public, giving each of us a wake-up call every time he opens his mouth.

      Right now, each of us in serious trouble. None of us has any inkling of an idea what we’re about to face on a national and global scale financially. It could be an hour from now. This government health insurance is a side-track.

      The gov’t cannot afford this for it’s people. So, in comes The Federal Reserve to print up useless dollars…counterfeit money that other countries no longer value.
      It’s time for the American people to take a verbal stance in full force, our presence, in Washington and demand to take back our country and and all it once stood for.

      We CAN do it, we just won’t. Everyone has their head in a pile of crap (sand)and refuses to see the truth. The only people looking out for us, will always be us…and we’re doing what our elected officials are doing. Looking the other way.
      That’s criminal!

  2. Jim said

    Your insight into the issue is extremely helpful. I have been blaming Obama for not taking a stand in terms of giving details to his plan. But you are correct that he is taking a huge risk. He will catch flack because a lot of TV talking heads are determined to bring him down. However, I could not agree with you more, he needs to clarify the details and do it soon. Thanks for a great post.

  3. I think Obama should have been making his thoughts known on this a while ago. This is probably the biggest bill affecting millions of Americans and they don’t know what the administration stand for because he was not spoken up. I see this as a complete lack of leadership.

    • Dave Wood said

      I dont know what you all are talking about. ALL the bills in the house and senate are based on what the Obama called for way back in 08 before the primarys.

      Edwards came out first, then Hillary had a half baked policy, then Obama. They all were very similar. Hillary had a individual mandate, Obama had one only for kids.

      The congress has just taken up the Obama plan and ran with it.

      In the end it doesnt even matter about the public option because COST is our main problem in American health care and Obama care will not reduce costs in our future, public option or not.

      Costs in American health care are driven by two main items, 1. the poor status of our health ie. obesity, stress, old age. and 2. the inefficient, wasteful, paperwork heavy, and unfair system itself.

      What does Obama care do for item 1 above? Almost nothing, thus ensuring our costs will rise and rise as the bills for the ever increasing rates of diabetes, asthma, and alzheimers to name a few, go up and up.

      And how about item 2 above? Obama care not only does nothing to reduce the systemic inefficiencies of duplicate billing, paying agents who do nothing, multi govt handling of payments, and incentives for MORE not better treatments, in fact Obamacare INCREASES these burdens with even more rules and regulations, more payments systems, and more complications to deal with.

      In fact Obamacare DOUBLES DOWN on the existing flawed and failing system.

      If you think health care is expensive now……….YOU AINT SEEN NOTHIN BABY!!!!

  4. Marly said

    The problem is, this is not being “hashed out in public debate” as stated by a previous comment. Who is representing the voice of the people? Lobbyists are making sure their voices are heard for sure. I think we have a perfect opportunity in this country to make a real difference. I agree with the post – time to make a stand! Marly

  5. Nosedoc said

    Two other articles (besides the link I provided under the previous post) worth reading from today’s NY Times:

    It is encouraging that there are high profile Republicans who recognize the need for substantive health care reform now and can be of value in the discussions on how best to proceed, particularly Drs. Frist and Thompson. Unfortunately, neither of them are in Congress.

  6. Czund One said

    When politicians want to advertise on radio, television or print, they must be given the lowest rate currently being given to another advertiser. Therefore, if a radio station (for example)is giving a “buddy” a $10.00 rate for a :30 second commercial, a politician must be given that same rate.

    Now, hospitals and physicians each negotiate rates with insurance companies for services rendered.
    The lowest rates are Medicaid HMO rates. If a patient presents in the E.R., the insurance company will pay the hospitals a negotiated rate, NO MATTER WHAT SERVICES ARE RENDERED. This includes CT scans, Labs, suturing, setting broken bones, any medications that are given, and includes the ER physician, radiologist interpretations and specialists called in to see the patient.
    The all-inclusive price is between $200.00 and $500.00, depending on the state and the county in that particular state.
    If a patient needs to be admitted, there is a set daily rate, THAT IS ALL-INCLUSIVE, NO MATTER WHAT SERVICES ARE RENDERED.
    That rate is anywhere between $150.00 to $250.00 PER DAY.
    ***This would include (for example) any surgery: Coronary By Pass, Appendectomy, Orthopedic, and on and on and on…
    This information should be made public by the hospital. People without insurance should not be charged any more than the lowest contracted rate the hospital is honoring at the time services are rendered. PERIOD!
    If heathcare in this country were handled in this manner, most of us wouldn’t require insurance to begin with. We could then afford to pay for services as events arose in our lives. A hospital stay wouldn’t be “catastrophic”.
    Health insurance coverage could then be for specific “catastophic” events, like neurosurgery resulting from cancer, auto injuries, or events that require ICU, ventilators, long-term care (for example).
    We shouldn’t need insurance to pay for drugs. Pharmacies should be required to make their contracted rates available to the public. The lowest contracted rate for medications should be available to everyone.
    Insurance drug coverage should be for things like chemotherapies (oral and I.V.), Home I.V. antibiotics.
    And while I’m still on my Soap Box, since drug companies give out samples to physicians, they need to be doling out samples to all pharmacies. There is absolutely no excuse for pharmacies not to give out free samples of a medication if they have a written prescription from a licensed physician! PERIOD!

  7. Alison said

    I am trying to be on board because I dont want to “throw the baby out with the bathwater” and I am left with such a heaviness in my heart feeling like so many things that might actually address this situation have been missed completely. I am scared in compromise to have something we are going to end up with trade offs that are terminal. I am a optimist and yet I am find it so hard to find a chair to sit in.

  8. C N said

    Although it is causing a great deal of trepidation among the Democrats, I support the way the President has let the details of this plan be hashed out in the public arena. Neither side “should” be able to say that the Administration forced a pre-packaged health care plan on America. Both political parties have had ample opportunity to state their case. Now Congress needs to listen and understand what private citizens (NOT corporate interest) want and act accordingly.

    I hope to see the President don the hat of Democratic Party Leader at this point and get the Democrats on the same page. If there is a time and place to use political capital, in my humble opinion, this is it!

  9. Marie said

    Obama will try harder then ever to push through this his Death Bill because — TRIAL DATE JANUARY 26,2010 ,,, OBAMA HAS A DATE WITH A FEDERAL DISTRICT COURT JUDGE ! ( Obama may be in deep doo-doo now ! ) At the hearing today at the Federal Court building in Santa Ana, Judge Carter said the following: (1.) There will be a trial. ( 2.) It will be heard on the merits. ( 3.) Nothing will be dismissed on procedural issues. ( 4. )The trial will be expeditious, and the judge pledged to give case priority.( 5.) Being a former Marine he realizes the importance of having a Constitutionally qualified POTUS/CINC .( 6.) Judge stated that if Obama isn’t Constitutionally qualified he needs to leave the White House.

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